How Much “Repeal” Must “Replace” Involve?

If you’re wondering why it’s taking so long for congressional Republicans to unite behind an Obamacare Replacement plan when there are several of them out there, look no further than the North Carolina U.S. Senate primary, where “Establishment” candidate Thom Tillis has incautiously said not all aspects of Obamacare are bad, yet appears to be afraid to endorse the “replacement” bill originally cosponsored by the senior senator from that state, Richard Burr. WaPo’s Greg Sargent has more:

Tillis has so far refrained from endorsing the Burr plan. And similarly, in interviews, he has claimed that of course he would replace Obamacare with something that would protect people with preexisting conditions and others who need protection, without specifying what that replacement would be. Republicans appear increasingly aware that they can’t be just for repeal, and have to promise replacements that would accomplishment some of what Obamacare accomplishes….

As the case of Tillis shows…Republicans must also simultaneously remain vague enough about those replacements so as to avoid embracing the tradeoffs they would require — since specificity there risks angering the right. Indeed, Tillis’ embrace of even some of Obamacare’s general goals has drawn fire from his primary opponent, Tea Partyer Greg Brannon.

The Coburn-Burr-Hatch proposal is dangerous politically for a primary-challenged Republican because it simultaneously embraces aspects of Obamacare (an insurance purchasing exchange, albeit one selling “deregulated”–which means less generous–products; and subsidies for purchases on those exchanges by certain low-income folk) and aspects of more conventional conservative health care thinking that are wildly disruptive of the status quo at a time when Republicans are making big hay over Obamacare “disruptions” (notably the partial rollback of the federal tax write-off for employer-based plans). Indeed, messing with employer-based coverage has been a conservative policy pet rock for years, even though GOP politicians have been leery of it since John McCain proposed junking it in 2008, and left himself exposed to a “tax increase” charge.

There simply isn’t, and can’t be, an “Obamacare replacement” proposal that lets everyone who likes the status quo keep it, while dealing with pre-existing condition exclusions, expanding coverage, and holding down costs. This is why Republicans prefer to insist they want to repeal Obamacare and are stilling “working” on a replacement, four years after enactment of the Affordable Care Act.